PROVIDER EDUCATION AND TECHNICAL ASSISTANCE.

SEC. 921. PROVIDER EDUCATION AND TECHNICAL ASSISTANCE.(a) Coordination of Education Funding.—(1) In general.—Title XVIII is amended by inserting after section 1888 the following new section:“provider education and technical assistance“Sec. 1889. (a) Coordination of Education Funding.—The Secretary shall coordinate the educational activities provided through medicare contractors (as defined in subsection (g), including under section 1893) in order to maximize the effectiveness of Federal education efforts for providers of services and suppliers.” .(2) Effective date.—The amendment made by paragraph (1) shall take effect on the date of the enactment of this Act.(3) Report.—Not later than October 1, 2004, the Secretary shall submit to Congress a report that includes a description and evaluation of the steps taken to coordinate the funding of provider education under section 1889(a) of the Social Security Act, as added by paragraph (1).(b) Incentives To Improve Contractor Performance.—117 STAT. 2389(1) In general.—Section 1874A, as added by section 911(a)(1) and as amended by section 912(a), is amended by adding at the end the following new subsection: “(f) Incentives To Improve Contractor Performance in Provider Education and Outreach.—The Secretary shall use specific claims payment error rates or similar methodology of medicare administrative contractors in the processing or reviewing of medicare claims in order to give such contractors an incentive to implement effective education and outreach programs for providers of services and suppliers.”.(2) Application to fiscal intermediaries and carriers.—The provisions of section 1874A(f) of the Social Security Act, as added by paragraph (1), shall apply to each fiscal intermediary under section 1816 of the Social Security Act (42 U.S.C. 1395h) and each carrier under section 1842 of such Act (42 U.S.C. 1395u) in the same manner as they apply to medicare administrative contractors under such provisions.(3) GAO report on adequacy of methodology.—Not later than October 1, 2004, the Comptroller General of the United States shall submit to Congress and to the Secretary a report on the adequacy of the methodology under section 1874A(f) of the Social Security Act, as added by paragraph (1), and shall include in the report such recommendations as the Comptroller General determines appropriate with respect to the methodology.(4) Report on use of methodology in assessing contractor performance.—Not later than October 1, 2004, the Secretary shall submit to Congress a report that describes how the Secretary intends to use such methodology in assessing medicare contractor performance in implementing effective education and outreach programs, including whether to use such methodology as a basis for performance bonuses. The report shall include an analysis of the sources of identified errors and potential changes in systems of contractors and rules of the Secretary that could reduce claims error rates.(c) Provision of Access to and Prompt Responses From Medicare Administrative Contractors.—(1) In general.—Section 1874A, as added by section 911(a)(1) and as amended by section 912(a) and subsection (b), is further amended by adding at the end the following new subsection:“(g) Communications With Beneficiaries, Providers of Services and Suppliers.—“(1) Communication strategy.—The Secretary shall develop a strategy for communications with individuals entitled to benefits under part A or enrolled under part B, or both, and with providers of services and suppliers under this title.“(2) Response to written inquiries.—Each medicare administrative contractor shall, for those providers of services and suppliers which submit claims to the contractor for claims processing and for those individuals entitled to benefits under part A or enrolled under part B, or both, with respect to whom claims are submitted for claims processing, provide general written responses (which may be through electronic transmission) in a clear, concise, and accurate manner to inquiries of providers of services, suppliers, and individuals entitled to 117 STAT. 2390 benefits under part A or enrolled under part B, or both, concerning the programs under this title within 45 business days of the date of receipt of such inquiries.“(3) Response to toll-free lines.—The Secretary shall ensure that each medicare administrative contractor shall provide, for those providers of services and suppliers which submit claims to the contractor for claims processing and for those individuals entitled to benefits under part A or enrolled under part B, or both, with respect to whom claims are submitted for claims processing, a toll-free telephone number at which such individuals, providers of services, and suppliers may obtain information regarding billing, coding, claims, coverage, and other appropriate information under this title.“(4) Monitoring of contractor responses.—“(A) In general.—Each medicare administrative contractor shall, consistent with standards developed by the Secretary under subparagraph (B)—“(i) maintain a system for identifying who provides the information referred to in paragraphs (2) and (3); and“(ii) monitor the accuracy, consistency, and timeliness of the information so provided.“(B) Development of standards.—“(i) In general.—The Secretary shall establish and make public standards to monitor the accuracy, consistency, and timeliness of the information provided in response to written and telephone inquiries under this subsection. Such standards shall be consistent with the performance requirements established under subsection (b)(3).“(ii) Evaluation.—In conducting evaluations of individual medicare administrative contractors, the Secretary shall take into account the results of the monitoring conducted under subparagraph (A) taking into account as performance requirements the standards established under clause (i). The Secretary shall, in consultation with organizations representing providers of services, suppliers, and individuals entitled to benefits under part A or enrolled under part B, or both, establish standards relating to the accuracy, consistency, and timeliness of the information so provided.“(C) Direct monitoring.—Nothing in this paragraph shall be construed as preventing the Secretary from directly monitoring the accuracy, consistency, and timeliness of the information so provided.“(5) Authorization of appropriations.—There are authorized to be appropriated such sums as are necessary to carry out this subsection.”.(2) Effective date.—The amendment made by paragraph (1) shall take effect October 1, 2004.(3) Application to fiscal intermediaries and carriers.—The provisions of section 1874A(g) of the Social Security Act, as added by paragraph (1), shall apply to each fiscal intermediary under section 1816 of the Social Security Act (42 U.S.C. 1395h) and each carrier under section 1842 of such 117 STAT. 2391 Act (42 U.S.C. 1395u) in the same manner as they apply to medicare administrative contractors under such provisions.(d) Improved Provider Education and Training.—(1) In general.—Section 1889, as added by subsection (a), is amended by adding at the end the following new subsections:“(b) Enhanced Education and Training.—“(1) Additional resources.—There are authorized to be appropriated to the Secretary (in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund) such sums as may be necessary for fiscal years beginning with fiscal year 2005.“(2) Use.—The funds made available under paragraph (1) shall be used to increase the conduct by medicare contractors of education and training of providers of services and suppliers regarding billing, coding, and other appropriate items and may also be used to improve the accuracy, consistency, and timeliness of contractor responses.“(c) Tailoring Education and Training Activities for Small Providers or Suppliers.—“(1) In general.—Insofar as a medicare contractor conducts education and training activities, it shall tailor such activities to meet the special needs of small providers of services or suppliers (as defined in paragraph (2)). Such education and training activities for small providers of services and suppliers may include the provision of technical assistance (such as review of billing systems and internal controls to determine program compliance and to suggest more efficient and effective means of achieving such compliance).“(2) Small provider of services or supplier.—In this subsection, the term ‘small provider of services or supplier’ means—“(A) a provider of services with fewer than 25 full-time-equivalent employees; or“(B) a supplier with fewer than 10 full-time-equivalent employees.”.(2) Effective date.—The amendment made by paragraph (1) shall take effect on October 1, 2004.(e) Requirement To Maintain Internet Websites.—(1) In general.—Section 1889, as added by subsection (a) and as amended by subsection (d), is further amended by adding at the end the following new subsection:“(d) Internet Websites; FAQs.—The Secretary, and each medicare contractor insofar as it provides services (including claims processing) for providers of services or suppliers, shall maintain an Internet website which—“(1) provides answers in an easily accessible format to frequently asked questions, and“(2) includes other published materials of the contractor,that relate to providers of services and suppliers under the programs under this title (and title XI insofar as it relates to such programs).”.(2) Effective date.—The amendment made by paragraph (1) shall take effect on October 1, 2004.(f) Additional Provider Education Provisions.—(1) In general.—Section 1889, as added by subsection (a) and as amended by subsections (d) and (e), is further amended by adding at the end the following new subsections:117 STAT. 2392 “(e) Encouragement of Participation in Education Program Activities.—A medicare contractor may not use a record of attendance at (or failure to attend) educational activities or other information gathered during an educational program conducted under this section or otherwise by the Secretary to select or track providers of services or suppliers for the purpose of conducting any type of audit or prepayment review.“(f) Construction.—Nothing in this section or section 1893(g) shall be construed as providing for disclosure by a medicare contractor—“(1) of the screens used for identifying claims that will be subject to medical review; or“(2) of information that would compromise pending law enforcement activities or reveal findings of law enforcement-related audits.“(g) Definitions.—For purposes of this section, the term ‘medicare contractor’ includes the following: “(1) A medicare administrative contractor with a contract under section 1874A, including a fiscal intermediary with a contract under section 1816 and a carrier with a contract under section 1842.“(2) An eligible entity with a contract under section 1893.Such term does not include, with respect to activities of a specific provider of services or supplier an entity that has no authority under this title or title IX with respect to such activities and such provider of services or supplier.”.(2) Effective date.—The amendment made by paragraph (1) shall take effect on the date of the enactment of this Act.